Addressing multiple problems in the family practice office visit

OBJECTIVES The purpose of the study was to describe the number of problems addressed during family practice outpatient visits. the nature of additiona l problems raised, how they affect the duration of the visit. and how well they are reflected in the billing record. STUDY DESIGN Cross-sectional. POPULATION We studied a total 266 randomly selected adult patient encounter s representing 37 physicians. OUTCOMES MEASURED A problem was defined as an issue requiring physician act ion in the form of a decision, diagnosis, treatment, or monitoring. Visit d uration and the number of billing diagnoses were also assessed. RESULTS On average, 2.7 problems and 8 physician actions were observed duri ng an encounter. More than one problem was addressed during 73% of the enco unters; 36% of these additional problems were raised by the physician and 5 8% by the patient. On average. each additional problem increased the length of the visit by 2.5 minutes (P <.001). The concordance between the number of problems observed and the number of problems on the billing sheet indica ted a trend toward underbilling the number of problems addressed. CONCLUSIONS Multiple problems are commonly addressed during family practice outpatient visits and are raised by both the physicians and the patients. Our findings suggest that current views of physician productivity and the b illing record are poor indicators of the reality of providing primary care.